POS1219 SARS-COV-2 COURSE AND OUTCOME IN PATIENTS WITH SYSTEMIC AUTOINFLAMMATORY DISEASES (SAID) TREATED WITH IL-1 INHIBITORS AND COLCHICINE
Authors: S. Bindoli, S. Della Mora, A. Doria, P. Sfriso
Journal: Annals of the Rheumatic Diseases (2022)

Background The spread of COVID-19 had a strong impact in north-east Italy especially during 2020 and in the first months of 2021. Patients affected by rheumatological disorders are at high risk of infections due to immunosuppressant therapies and a clear immunological imbalance. However, some anti-cytokines such as IL-1 inhibitors proved to be effective in curbing the cytokine storm, frequent feature of severe COVID-19. Objectives We assessed the SARS-CoV-2 clinical course in 28 patients affected by autoinflammatory diseases, referring to the Autoinflammatory Outpatient Clinic of Padova University; in particular we observed if patients undertaking IL-1 inhibitors (group-1) had a diverse outcome compared to those not on anti-IL-1 drugs (group-2). Methods Through telephone or e-mail consultancy, 28 patients (18 females, mean age 39.5±15), confirmed to have contracted COVID-19 between March 2020 and January 2022. Twelve patients (42.8%) were affected by periodic fevers (FMF/TRAPS), 10/28 (35.7%) had Adult-Onset Still’s Disease, 3/28 (10.7%) had Undifferentiated Autoinflammatory Diseases, while 2/28 (7.1%) were affected by Behçet Disease and one patient had Schnitzler Syndrome. 12 out of 28 patients (42.8%) were undertaking IL-1 inhibitors; 8/28 (28.5%) were in therapy with colchicine; 2 patients were in therapy with methotrexate and abatacept respectively, and 6/28 (21.4%) received no therapy. All were diagnosed with COVID-19 after molecular nasopharyngeal swab performed either for the presence of symptoms or close contact with a positive subject. 5/28 patients had the infection after receiving the second vaccine shot, two after the booster dose. All the others had COVID-19 before the vaccine injection. GraphPad5 was used for statistical analysis and Fisher’s test was applied. Results COVID-19 clinical course was benign in 27 out of 28 patients (96.4%); a total of 29 infections were counted due to a case of re-infection; 2 patients discontinued the therapy; all the others continued their medications (92.8%). Two patients (7.1%) of the entire cohort were hospitalized, one died. Regarding the major symptoms (fever ≥ 38 C°, cough/respiratory or gastro-intestinal symptoms) no difference was noticed between group-1 and group-2 (p=0.449); despite group-1 required less symptomatic therapy than group-2, the difference was not significant (p=0.471). Table 1 summarizes the clinical features exhibited by the patients and the therapies undertaken during the infection. Table 1. Clinical features and therapies of the examined cohort Total COVID-19 infections (%)29 (100) Group-1 (anti IL-1 drugs) 12 (41.3) Group-2(no anti IL-1 drugs) 17 (58.6) COVID-19 symptomatic therapy Acetaminophen 4 (13.7) 0 4 (23.5) NSAIDs 8 (27.5) 3 (25) 5 (29.4) Other (corticosteroids, mAb°) 5 (17.2) 3 (25) 2 (11.7) Total 17 (58.6) 6 (50) 11 (58.8) No therapy for COVID-19 12 (41.3) 6 (50) 6 (35.2) COVID-19 major symptoms * 10 (34.4) 3 (25) 7 (41.1) COVID-19 minor symptoms ** 16 (48.7) 8 (66.6) 8 (47) COVID-19 asymptomatic 3 (10.3) 1 (8.3) 2 (11.7) Discontinuation of therapy 2 (6.8) 0 2 (11.7) Outcome Home 27 (93.1) 11 (91.6) 16 (94.1) Hospitalization (and fully recovered ) 1 (3.44) 1 (8.33) 0 Death 1 (3.44) 0 1 (5.8) Infection after receiving vaccine (at least II doses) 7 (24.13) 5 (41.6) 2 (11.7) Legend: *(Fever ≥ 38 C°, cough/pneumonia, important gastro-intestinal symptoms); **(Fever &lt; 38 C°, anosmia, ageusia, asthenia, arthralgias); °Monoclonal antibodies Conclusion Despite the low sample size, our study is of interest since it proves that the inhibition of IL-1 with both anakinra or canakinumab and the employment of colchicine, an important inflammasome regulator, may curb the hyperinflammation typical of COVID-19. Given the promising results obtained with anti-IL-1 and colchicine in treating severe COVID-19, it is conceivable a “protective” role of these drugs in preventing a massive cytokine release. Unsurprisingly, none of our patients but one, had a severe course or fatal outcome after SARS-CoV-2 infection. Disclosure of Interests None declared